伴与不伴泌尿系结石的原发性甲状旁腺功能亢进症的临床特征分析  

Clinical analysis of primary hyperparathyroidism with and without urinary calculi

作　　者：昌亮亮 王杰[1] 胡代星 蒋立[1] 唐伟[1] 罗生军[1] CHANG Liangliang;WANG Jie;HU Daixing;JIANG Li;TANG Wei;LUO Shengjun(Department of Urology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Breast and Thyroid Surgery,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016 [2]重庆医科大学附属第二医院乳腺甲状腺外科,重庆400010

出　　处：《重庆医学》2023年第19期2977-2982,共6页Chongqing medicine

摘　　要：目的分析原发性甲状旁腺功能亢进症(PHPT)伴或不伴泌尿系结石的临床特征。方法回顾性分析2011-2020年于重庆医科大学附属第一医院手术治疗的99例PHPT患者,比较62例结石患者与37例非结石患者,以及结石患者中11例结石复发患者与36例结石未复发患者的病理结果、年龄、BMI、术前全段甲状旁腺激素(PTH)、血清钙、血清磷、血清碱性磷酸酶、24 h尿钙等指标,甲状旁腺切除术后复查血清PTH及血清钙。结果PHPT结石组患者血清钙、PTH、24 h尿钙水平及高尿钙构成比明显高于PHPT无结石组(P<0.05),而血清磷水平明显低于PHPT无结石组(P<0.05)。两组病理类型、性别组成、年龄、BMI、血清肌酐、尿素氮、血清碱性磷酸酶、肾小球滤过率、24 h尿磷、术后血清PTH、术后血清钙水平比较差异无统计学意义(P>0.05)。所有患者行甲状旁腺切除术后血清PTH与血清钙水平均恢复正常。PHPT结石组患者随访时间(58.8±29.9)个月,甲状旁腺切除术后仍有23.4%(11/47)的患者有结石复发,结石复发组患者年龄明显低于结石未复发组(P<0.05)。结论血清PTH、血清钙、尿钙水平升高可增加泌尿系结石形成风险,甲状旁腺切除术有助于降低PHPT结石患者的结石复发率,年轻患者更容易导致结石复发。Objective To analyze the clinical characteristics of primary hyperparathyroidism(PHPT)with or without urinary calculi.Methods A total of 99 patients with PHPT who underwent surgical treatment in the First Affiliated Hospital of Chongqing Medical University from 2011 to 2020 were retrospectively analyzed,62 patients with stones and 37 patients without stones were compared.Pathological findings,age,BMI,preoperative whole parathyroid hormone(PTH),serum calcium,serum phosphorus,serum alkaline phosphatase,24-hour urinary calcium and other indicators of 11 patients with recurrent stones and 36 patients without recurrent stones were also reported.Serum PTH and serum calcium were reexamined after parathyroidectomy.Results The levels of serum calcium,parathyroid hormone,24-hour urinary calcium and the proportion of high urinary calcium in PHPT patients with calculi were significantly higher than those in PHPT without calculi group(P<0.05),while the level of serum phosphorus was significantly lower than that in PHPT without calculi group(P<0.05).There were no significant differences in pathological type,gender composition,age,BMI,serum creatinine,urea nitrogen,alkaline phosphatase,glomerular filtration rate,24-hour urine phosphorus,postoperative PTH and serum calcium levels between the two groups(P>0.05).The levels of PTH and serum calcium returned to normal after parathyroidectomy(PTX)in both groups.By retrospective follow-up of patients in the PHPT stone group[median follow-up period(58.8±29.9)months],23.4%(11/47)of patients still had new stone activity after PTX.The age of patients in the stone recurrence group was significantly younger than that in the stone non-recurrence group(P<0.05).Conclusion Elevating levels of serum PTH,serum calcium,and urinary calcium can increase the risk of urinary stone formation.Parathyroidectomy can help reduce the recurrence rate in patients of PHPT stones,and young patients are more likely to cause stone recurrence.

关 键 词：泌尿系结石 原发性甲状旁腺功能亢进症 甲状旁腺切除术 高尿钙症 术后随访 

分 类 号：R692.4[医药卫生—泌尿科学]